MTMS in Medicare: Critical to the Future of Pharmacy

Edward J. Staffa, RPh

Published Online: Tuesday, February 1, 2005

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How long have you been a
pharmacist? The chances are
good, no matter how long it
has been, that you have heard plenty
about payment for nondispensing
pharmacy services. Unfortunately, the
chances also are good that you have
seen little evidence of such payments.
That situation may soon change.

By now, it is well known that the
Medicare Modernization Act (MMA)
of 2003, which goes into effect fully in
January 2006, will cover prescription
medications for Medicare beneficiaries.
The MMA, however, calls for
another critical Medicare service:
Medication Therapy Management
Services (MTMS). Beginning in 2006,
the nation's largest payer of health
care services, the US government, will
pay for the medication management
services of potentially millions of eligible
Medicare beneficiaries. What an opportunity
for payment for nondispensing
services!

What exactly is MTMS? As a pharmacist,
you may have a very clear idea
of what such a service entails. After all,
you do it every day. Unfortunately,
however, there is no clear, widely
accepted definition of this term in our
health care system. Pharmacy is working
hard to establish such a definition
and, importantly, to make the pharmacist
the primary provider of this
service. In July 2004, the profession of
pharmacy took a big step forward in
helping to define MTMS. Convened
by the American Pharmacists Association,
11 national pharmacy organizations
hammered out a 1-page definition
of MTMS (see Pharmacy Times,
January 2005, page 72, or visit
www.aphanet.org). We have been
using that definition to communicate
our vision of MTMS to others outside
of pharmacy, such as the Centers for
Medicare and Medicaid Services, the
federal agency responsible for administering
the Medicare MTMS benefit.

Will pharmacists provide Medicare's
MTMS? The answer is up to us. The
regulations governing the MMA,
including those for MTMS, have just
appeared. In those regulations, pharmacists
are mentioned as possible
MTMS providers, but the services are
not being handed exclusively to us.
Between now and 2006, many health
care providers and health care organizations
also will be looking to become
MTMS providers.

In an age of Internet pharmacies,
mandatory mail-order pharmacy services,
and illegal importation of prescription
medications from Canada
and other foreign countries, it is more
important than ever for pharmacists to
demonstrate their value to the health
care system. Providing effective MTMS
represents a critical opportunity for our
profession. Pharmacists are the ideal
health care providers for MTMS. Let us
step up and demonstrate that fact to all
of health care. We will need the support
of every pharmacist!

Mr. Staffa is vice president of pharmacypractice and communications at the NationalAssociation of Chain Drug Stores.